weeks 1-3 (ch 1, 2, 3, 21, 18, 19, 20, 12, 13, & 14)

What is the primary reason women with small children are homeless? a. Domestic abuse b. Lack of education c. Lack of employment d. Lack of job skills

A Although lack of education and job skills makes it difficult to find employment and funds with which to pay for housing, the primary reason a woman with small children would be homeless is a result of domestic abuse.

Why do many migrant/seasonal workers not complain about their poor living conditions? a. Being undocumented, they risk discovery and deportation b. Conditions here are so much better than in their original home c. There is nothing a nurse can do about housing conditions d. It is not a part of their ethnic group's culture to complain

A Although the other reasons may also be true, the main reason this population does not complain is because many migrant/seasonal workers are undocumented and fear discovery and deportation

A homeless veteran, who finds his posttraumatic stress disorder so overwhelming that he cannot deal with society, lives by the river underneath a bridge, in a large packing crate, and seems to have adapted to his situation. Which of the following best describes this type of homelessness? a. Chronic b. Episodic c. Not really homelessness d. Temporary

A Because this is an ongoing, apparently permanent situation to which the veteran has adapted, this has become the norm for him, hence chronic.

Which of the following would a homeless adolescent see as an important survival skill? a. Being able to beg, manipulate, and lie to obtain resources b. Using free clinics to obtain access to health care providers c. Trying to keep a list of all social programs in the community d. Trying to look and act like a middle class member of society

A Homeless youths adapt quickly to life on the street, where they are subject to criminal victimization such as learning to solicit money and drugs through prostitution.

Which of the following is the primary reason that only a small percentage of those eligible participate in COBRA insurance? a. COBRA is too costly for most eligible people. b. They do not think it is important to have health care insurance. c. Medicaid is a more effective choice to obtain health care. d. They are healthy and are willing to not carry insurance.

A Over 90% of people choose not to participate in the COBRA plan because of the cost of the premiums

A community/public health nurse is caring for clients living at a local homeless shelter. Which of the following would be most likely expected of many of the clients? a. Many suffer from alcohol or drug abuse or are mentally ill. b. Many are extremely violent and dangerous to be around. c. Many receive free care at the local public health clinics. d. Many suffer from acute illnesses resulting from exposure to weather extremes.

A Research demonstrates that the majority of the homeless are men, many are veterans, almost one third abuse alcohol or other drugs, and one fourth will be mentally ill.

Facing the changes in society, what have most state and local governments chosen to do? a. Cut programs for low-income families to balance the budget b. Cut programs that primarily serve the middle class c. Increase taxes to meet revenue requirements d. Ignore any federal mandates that are unfunded

A States have had to contend with shrinking revenues and increased program responsibilities and federal mandates. States have used program cuts, especially in programs serving low-income families, as the primary method for balancing their budgets.

A 66-year-old woman is retired and no longer has health insurance through her place of employment. Which of the following programs would be appropriate for her health insurance needs? 1. Medicare 2. Medicaid 3. Social Security 4. Economic Opportunity Act

ANS: 1 The Social Security Act was amended to include health insurance benefits for the elderly, which is addressed through Medicare.

Nurses who provided care to people in their homes and provided that care to several people at a time were called: 1. Private duty nurses 2. Visiting nurses 3. Public health nurses 4. Community staff nurses

ANS: 2 Correct by definition

A major provision of the Social Security Act of 1935 was the establishment of: 1. The Frontier Nursing Service to provide nursing service to rural communities 2. State and local community health services and training of personnel 3. District nursing to provide home health care to sick people 4. Community-based settlement houses

ANS: 2 Title VI of the Social Security Act established state and local community health services and training of personnel.

What conclusions can be drawn when comparing the prison population in the United States to the general adult population in the United States? Select all that apply. a. More prisoners are from low-income, single-parent homes. b. More prisoners have been diagnosed with a mental problem and substance abuse. c. More prisoners are exposed to drug trafficking, weapons, and gang violence. d. More prisoners have a lower level of education. e. More prisoners receive better and more extensive health care. f. More prisoners have a decreased risk of injury while incarcerated.

A, B, C, D Statistical analysis of research demonstrates that vulnerable populations are overrepresented in juvenile justice and adult prison systems. Prisoners are more likely to come from single-parent homes and poverty, have lower levels of education, and have been exposed to drug trafficking, weapons, and gang violence. There is a disproportionate representation of racial minorities. Prisoners report more physical health problems, just more than 50% have a mental problem, and the risk of injury increases with time served.

Even though the nurse may be employed to do a specific task or engage in specific programs, in what activities can the nurse engage to continue to help vulnerable groups in the community? Select all that apply. a. Consider every contact with clients an opportunity to ask about the health of their family members b. Engage in extensive multiphasic testing to diagnose other possible medical problems c. Screen for potential problems while engaging in the tasks for which the nurse is reimbursed d. Voice ongoing concern about the needs of the agency for ongoing funding to all the clients seen at the agency

A, C Although the nurse must complete the responsibilities of the nurse's employing agency, the nurse can multitask through screening and interviewing each person or family concerning their health and the health of their family members while engaging in the required tasks. Voicing concern about funding to individual clients is not an effective way to change the health care system. Multiphasic testing would be wonderful but is not affordable in either time or other resources.

What should the nurse be sure to include in the research design when involved in community/public health research? Select all that apply. a. Accurate data collection systems b. Carefully worded research hypotheses and definition of terms c. Cost/benefit measures as part of the research design d. Detailed tables of the study's sample and population demographics e. Established outcome measures f. Lengthy detailed title and abstract to the study

A, C, E In the current climate of economic retrenchment, cost concerns must be addressed as part of any intervention strategy. All studies should have cost/benefit measures as part of the research design. Nurses must document the effects of poor, improved, or good service through accurate data collection systems with established outcome measures. Different research approaches may or may not have research hypotheses, definition of terms, and summaries of the study's sample.

Although it was not part of the nurse's employment responsibilities, the nurse often volunteered to speak before community groups as well as legislators. Why would the nurse choose to do this? Select all that apply. a. Advocacy is an ethical and professional responsibility of all nurses. b. Engaging in such actions will increase the nurse's personal and professional visibility. c. Speaking before such groups may well result in a promotion and an increased pay scale for the nurse when the nurse's expertise is publicly recognized. d. Such public speaking is part of the nurse's role in most public health agencies. e. The nurse may recognize that many people are truly not aware of the problems experienced by vulnerable groups.

A, E Public speaking is not a requirement of the nurse's role in most agencies. Nonetheless, the nurse may recognize that many people are truly not aware of the problems experienced by vulnerable groups. Speaking out helps increase public awareness. Furthermore, the ethical code for nurses states: "The nurse provides services with respect for human dignity and the uniqueness of the client, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems." In other words, the nurse seeks to obtain care for clients and, if necessary, to seek funding for that care through political action.

What is the purpose of the National Response Framework? a. Create a new branch of government that deals with bioterrorism. b. Establish a way for the Red Cross to carry out its mission. c. Develop a nationwide all-hazards approach to domestic incident management. d. Extend presidential power to act quickly upon weapons of mass destruction.

c. Develop a nationwide all-hazards approach to domestic incident management.

Between 1900 and 1955, the leading causes of mortality were pneumonia, tuberculosis, and diarrhea/enteritis. By mid-century, nurses faced new challenges as the leading causes of death became: 1. Heart disease, cancer, and cerebrovascular disease 2. Influenza 3. Tropical diseases from increased travel abroad 4. Diseases from overcrowded conditions in large cities

ANS: 1 Chronic illness care, long-term illness and disability, and disease prevention became the new challenges for nurses.

Neighborhood centers that provided health care and social welfare programs were called: 1. Settlement houses 2. Nursing care centers 3. Nurse-managed clinics 4. Public health services

ANS: 1 Correct by definition. Nursing centers, nurse-managed clinics, and public health services are not necessarily in neighborhoods.

Which of the following trends in health issues in the United States between 1900 and 1955 is accurate? 1. There was a rise in chronic disease such as heart disease and cancer. 2. There was a rise in communicable disease. 3. The crude mortality rate increased dramatically. 4. The life span after diagnosis remained the same.

ANS: 1 Leading causes of death in 1955 were heart disease and cancer, while in 1900 they were pneumonia and tuberculosis. All other answers are false.

The impact of World War I on public health nursing included which of the following? Select all that apply: 1. Many communicable diseases were eradicated. 2. The depletion of the ranks of public health nurses to the war. 3. The feeling that the greatest patriotic duty was to stay at home. 4. Inadequate funding was the major obstacle to extending nursing services in the community.

ANS: 2, 3, 4 Both World Wars I and II depleted the public health nurse population as nurses went off to war. The feeling of patriotism extended to the idea that patriotic duty could also be served on the home front.

Ruth Freeman was a leading public health educator, administrator, consultant, author, and leader of the National Health Organization of the twentieth century. Which of the following characterize her philosophy of nursing? 1. Nursing should move from acute care to community-based care. 2. Nurse practitioners should control public health. 3. Nursing is about caring for people, and is also intellectually challenging and offers many professional opportunities. 4. All nurses should seek graduate education to increase their credibility.

ANS: 3 Ruth Freeman felt that nursing was about caring for people and was also intellectually challenging and offered many professional opportunities. She did not specifically espouse the other statements.

An accomplishment for which the Frontier Nursing Service was noted is: 1. Improvement of the care of sick and injured soldiers 2. Establishment of a fee-for-service program for workers at Metropolitan Life Insurance Company 3. Reduction of infant and maternal mortality regardless of environmental conditions 4. Increasing funding for communicable disease treatment

ANS: 3 The Frontier Nursing Service nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality.

The Elizabeth Poor Law of 1601 is similar to which of the following current laws? 1. Welfare 2. Food Stamps 3. Medicaid 4. Medicare

ANS: 3 The Poor Law guaranteed medical care for poor, blind, and "lame" individuals, similar to Medicaid.

In 1909, Yssabella Waters published her survey Visiting Nurses in the United States. This document highlighted the fact that: 1.Nurses were trained by Boards of Education. 2.Trained nurses adequately covered less densely populated areas. 3.Visiting nurses services were concentrated in the northeastern quadrant of the nation. 4.Nurses were curing diseases such as tuberculosis and typhoid fever that greatly enhanced their credibility.

ANS: 3 This report emphasized the fact that visiting nurse services were concentrated in the northeast, which underscored the need for rural health.

Nurses have worked in the community to improve the health care status of individuals, families, populations, and vulnerable groups. Part of the appeal of this type of nursing is: 1. Working with wealthy contributors who provide the funds 2. Locating the source of disease and curing patients 3. The autonomy of practice and independence in problem solving and decision making 4.Caring for soldiers on the battlefield

ANS: 3 Community health nurses have a long history of autonomous practice, problem solving, and decision making. The other three answers relate to acute care nursing or gathering funding. Community health care nurses did engage in these activities in the nineteenth century, but overall, they have been best known for autonomy of practice.

Which of the following programs provided funds for neighborhood health centers, Head Start, and other community action programs? 1. Medicare 2. Medicaid 3. Social Security 4. Economic Opportunity Act

ANS: 4 Funding for neighborhood health centers, Head Start, and other community action programs began in 1964 with the Economic Opportunity Act.

An intervention by the United States federal government to protect the health of its citizens was the establishment of the Marine Hospital Service, presently known as the Public Health Service. Its purpose was to: 1. Set policy on quarantine legislation for immigrants 2. Establish hospital-based programs to care for the sick at home 3. Establish and promote environmental interventions such as adequate housing and sanitation for urban cities 4. Provide health care for merchant seamen to protect seacoast ports and cities from epidemics

ANS: 4 Providing health care to seamen was an early effort by the federal government to improve public health. Its purpose was to secure its maritime trade and seacoast cities.

A nurse is planning to conduct research on patient care outcomes. Which of the following agencies would the nurse use as a resource? a. Agency for Health Care Research and Quality b. Federal Agency for Patient Care Outcomes c. National Center for Nursing Research d. U.S. Agency for Patient Care Effectiveness

ANS: A The Agency for Health Care Research and Quality conducts research on health care systems, health care quality and cost issues, access to health care, and effectiveness of medical treatments. It provides evidence-based information on health care outcomes and quality of care. DIF: Cognitive Level: Apply (Application) REF: p. 42

A public health agency is planning to implement the electronic health record. Which of the following is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standards

ANS: A The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors. DIF: Cognitive Level: Apply (Application) REF: p. 37

The public health nurse must participate in the essential services of public health. These include: a.Monitoring health status by completing a community assessment b.Diagnosing and investigating health problems in the world c.Informing, educating, and empowering people about health issues d.Working in law enforcement to regulate health and ensure safety

c. Informing, educating, and empowering people about health issues

In the past, community-oriented nurses have been called: a. District nurses b. Almshouse nurses c. Soldier nurses d.Sisters

ANS: A In the past, community-oriented nurses have been called public health nurses, district nurses, visiting nurses, school nurses, occupational health nurses, and home health nurses.

A nurse is working at a state health department. Which of the following duties would most likely be completed in this setting? (Select all that apply.) a. Administering the Medicaid program b. Assessing the health needs of the state's citizens c. Employing and supervising school health nurses d. Establishing and maintaining free clinics for HIV-positive drug abusers

ANS: A, B State health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health care financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health departments in such areas as ongoing assessment of health needs. DIF: Cognitive Level: Apply (Application) REF: pp. 38, 44

What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that apply.) a. Approximately 12% of the U.S. population was born in a different country. b. Hispanics are the largest minority group population. c. Households consisting primarily of intact families continue to grow. d. Mortality for both genders in all age groups declined.

ANS: A, B, D Demographic figures confirm that 12% of the current U.S. population is foreign-born, with most immigrants coming from Latin America and about half as many from Asia. Families make up about 69% of all households, a decline from 81% in 1970. Although African Americans used to be the largest minority group, as of 2003, Hispanics now have that distinction. The population of the United States continues to increase, and mortality for both genders from all age groups has declined. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 34-35

Which of the following statements are accurate descriptions of current social and economic trends in the United States? (Select all that apply.) a. Citizens are appreciating the quality of life enjoyed in the United States. b. Enjoying life is not as important as the need to take care of oneself. c. Many families are seeing decreases in family income. d. Massive and unexpected social and economic changes have occurred.

ANS: A, C, D One of the social trends influencing health care is a growing appreciation of the quality of life. The first decade of the twenty-first century has added massive and unexpected changes to health, economic, and social conditions in the form of terrorist attacks, hurricanes, fires, floods, and infectious diseases. In addition to layoffs, outsourcing, and other economic forces, many families are seeing wage decreases. DIF: Cognitive Level: Understand (Comprehension) REF: p. 35

Which of the following provides evidence that the U.S. health care system is in crisis? (Select all that apply.) a. Full-time employees may not have health insurance as a benefit. b. Incompetent or negligent nurses are an ongoing source of medical errors. c. Long work hours and provider fatigue are a major factor in medical errors. d. More punitive measures must be taken to decrease provider errors.

ANS: A, C Although 61% of the non-elderly population continues to obtain health insurance through their employer as a benefit, employment does not guarantee insurance. As a result of the nursing shortage, nurses work longer hours and provider fatigue is a major factor in errors. The Institute of Medicine's (IOM) report To Err Is Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system failures by designing safety into the process of care. DIF: Cognitive Level: Understand (Comprehension) REF: p. 37

African-American females have a higher mortality rate from breast cancer than White females. This is an example of: a. Projection b. Disparity c. Racism d. A sentinel event

ANS: B Disparities are racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention. DIF: Cognitive Level: Apply (Application) REF: p. 34

How does managed care attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider's permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services

ANS: B Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primary care providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers).

Which of the following best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages self-management c. Focused on health promotion and disease prevention for everyone enrolled in the health center d. Local efforts to meet the Declaration of Alma Ata principles

ANS: B Primary health care is generally defined as essential care made universally accessible to individuals and families in a community with their full participation and at a cost that the community can afford. DIF: Cognitive Level: Understand (Comprehension) REF: p. 39

A community health nurse is trying to increase enrollment in SCHIP. Which of the following interventions would be most effective? a. Explaining the program to children enrolled in public school systems b. Handing out SCHIP applications to uninsured children seen in local hospital emergency departments c. Having a newspaper campaign with information and applications printed in the newspaper d. Sending literature about the SCHIP program home with schoolchildren each year

ANS: B SCHIP builds on Medicaid to provide insurance coverage to low-income, uninsured children who are not eligible for Medicaid. Thus, the population that needs to be targeted for SCHIP is those being seen for medical care who do not have insurance. DIF: Cognitive Level: Apply (Application) REF: p. 37

Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate more closely in the last few years? a. Increased administrative pressures to demonstrate outcomes b. Increased focus on emergency preparedness and response c. Increased taxpayers' complaints and general unhappiness d. Increased pressure to decrease overlap in services

ANS: B Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies. DIF: Cognitive Level: Understand (Comprehension) REF: p. 45

What would most likely occur during the preparedness stage of disaster management? a. Heightened inspection and increased security in the community b. Incorporation of provision of pets into local disaster plans c. Purchase of personal protective equipment for all citizens d. Assembly of disaster kits for the home, workplace, and car

d. Assembly of disaster kits for the home, workplace, and car

An example of community preparedness for a disaster is: a. Assembling emergency supplies b. Understanding the workplace disaster plan c. Taking a disaster training course d. Developing an evacuation plan to remove individuals from danger

d. Developing an evacuation plan to remove individuals from danger

A nurse is explaining the health care system in the United States to a group of physicians visiting from South America. How would the nurse best describe the current health care system? a. "It is a logical, rational approach to meeting expressed needs while still trying to control costs." b. "It is a system in the process of reform as problems have become increasingly apparent." c. "It is divided primarily into two components: private health care and public health care." d. "It is the best in the world with outstanding research and high-technology care available to all."

ANS: C Health care in the United States consists of a personal care system and a public health system, with overlap between the two. DIF: Cognitive Level: Apply (Application) REF: p. 39

How does the Department of Agriculture promote the health of U.S. citizens? a. By collecting surplus food left after mechanical harvests and distributing it to the poor b. By inspecting food, so no foodborne illnesses can occur c. By collaborating with others to provide food or food stamps to needy persons d. By providing direct education and grants to dietitians and nutritionists

ANS: C The Department of Agriculture collaborates with state and local government welfare agencies to provide food stamps to needy persons to increase their food-purchasing power. Other programs include school breakfast and lunch programs; the Supplemental Food Program for Women, Infants, and Children (WIC); and grants to states for nutrition education training. The Department of Agriculture also engages in plant, product, and animal inspections, but limited funding prevents absolute surety that food is safe to eat

Which organization would a nurse collaborate with when developing and coordinating an emergency response plan for a community? a. American Red Cross (ARC) b. Stress Management in Disaster Program (SMID) c. Centers for Disease Control and Prevention (CDC) d. Emergency Management Agency (EMA)

d. Emergency Management Agency (EMA)

An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. "Let's go through these medications and see which ones we can delete." b. "You can get these medicines at this clinic for free." c. "Let's see if we can get some help from Medicare to help you pay for these medications." d. "These medications are important. Do your best to pay for them."

ANS: C This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions. DIF: Cognitive Level: Analyze (Analysis) REF: p. 40

Following a disaster, what is the priority of the disaster response? a. Clean up the environment. b. Handle the stress reaction of the victims. c. Bring in as many aid workers and nurses as possible. d. Reestablish sanitary barriers and focus on basic needs.

d. Reestablish sanitary barriers and focus on basic needs.

In which situation would a nurse experience vicarious traumatization? a. When sustaining an injury during the disaster b. When exhausted and unable to adjust to the pace at home c. When frustrated about the response time during the disaster d. When listening to survivors' stories about traumatic events

d. When listening to survivors' stories about traumatic events

A nurse is determining which health care services must be offered at a local public health clinic. Which of the following factors is most important for the nurse to consider? a. Data available from the most recent community assessment b. Suggestions from community members about what is needed c. Recommendations of Healthy People 2020 d. Services mandated by the state government

ANS: D At the local level, health departments provide care that is mandated by state and federal regulations. DIF: Cognitive Level: Apply (Application) REF: p. 40

Which is an example of a bioterrorism and emergency readiness competency for a public health worker? a. Recognition of unusual events that might indicate an emergency b. Involvement in the chain of command c. Using a set of preplanned activities for every disaster d. Leaving communication to the authorities

a. Recognition of unusual events that might indicate an emergency

Which of the following principles has been used by the American Nurses Association (ANA) when encouraging health care reform? a. High-technology interventions to reduce nursing time, effort, and medical errors must be expanded. b. Nurses must be recognized and rewarded for health promotion efforts. c. Nursing research into patient care outcomes must be expanded and funded. d. Universal access to essential health services should be available for all citizens.

ANS: D The ANA's position is based on the belief that health care is a basic human right. Thus, a restructured health care system must ensure universal access to a standard package of essential health care services for all citizens and residents. DIF: Cognitive Level: Understand (Comprehension) REF: p. 47

The American Red Cross, through its Rural Nursing Service, improved living conditions in villages and isolated farms. Which of the following is an example of the resourcefulness of a nurse of this era? 1.Using hot bricks, salt, or sandbags to substitute for hot water bottles 2.Testing well water for pollutants 3.Teaching school and developing curricula for rural nursing programs 4.Providing post-surgical care

ANS:1 In providing medical care, rural nurses were resourceful in finding alternatives when they did not have medical products that were available in urban areas.

In the late 1800s, local health departments were formed in urban areas for what purpose? 1.To target environmental hazards associated with crowded living conditions and dirty streets and to regulate public baths, slaughterhouses, and pigsties 2.To facilitate interdisciplinary efforts and promote the "practical application of nursing" 3.To provide immunizations to all citizens 4.To provide public health education for nurses who had finished basic "training school" education

ANS:1 Local health departments were formed to handle environmental issues in cities.

Which of the following is true about African American nurses in public health? 1.Segregation existed until the 1960s, which made certificate and graduate education more difficult to obtain. 2.Cities were the major areas where they practiced 3. They often belonged to the Frontier Nursing Service. 4.They were recruited heavily as military nurses.

ANS:1 The other statements listed are false.

During America's Industrial Revolution, the number of jobs for women rapidly increased. Nightingale's successes became known across the United States, and the first nursing schools opened. Which of the following occurred related to public health nursing? 1.Community-oriented nursing began with organizations formed to meet urban health care needs. 2.Nurses were instrumental in the construction of sewers and public water systems. 3.Nurses trained in hospitals worked long hours caring for patients with communicable diseases in a humane way. 4.Nurses closed down almshouses and orphanages.

ANS:1 The visiting nurse became the key to health care in urban areas. Although nurses were involved in interventions to improve sanitation and nutrition, they were not instrumental in their construction. Nurses worked in hospitals, but that was acute care. Almshouses and orphanages were not closed down at this time.

Lina Rogers became the first school nurse. Early school nursing focused on: 1.Investigating causes of absenteeism such as malnourishment and lack of shoes or clothing 2.Teaching school as well as being a nurse 3.Starting the first school of public health 4.Providing medical treatment to enable children to return to school

ANS:1 Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians.

Florence Nightingale's contributions to public health included: 1.Caring for the sick, poor, and neglected in institutions and at home 2.Using a population-based approach that led to improvements in environmental conditions 3.Writing the Elizabethan Poor Law to guarantee medical care for all 4.Founding of the district nursing association to provide health care to needy people

ANS:2 During the Crimean War, Nightingale progressively improved the soldiers' health by adopting a population-based approach that used simple epidemiological measures and greatly decreased mortality.

Lillian Wald invented the term public health nursing. Which of the following classes might a person of her day attend? 1.Taking and recording blood pressures accurately 2.Safe and sanitary baby and child care 3.Environmental pollutants and their effects on lung disease 4.Time management: balancing factory work and the home

ANS:2 Lillian Wald provided health care that included educating the community on health care matters.

The National Organization for Public Health Nursing was formed in 1912. Lillian Wald was its first president. The mission was to improve the educational and services standards of the public health nurse and promote public understanding. Which of the following is a contribution of this organization? 1.Requiring that public health nurses have a baccalaureate degree in nursing 2.Standardization of public health nursing education 3.Development of nursing cooperatives 4.Opening of the Henry Street Settlement

ANS:2 The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet.

Threats to health from communicable diseases, the environment, chronic illness, and the aging process have changed over time. The newer threats to health in the United States that community health nurses are currently faced with include: 1.Diphtheria, cholera, and typhoid fever 2.HIV, AIDS, and bioterrorism 3.Avian flu, tuberculosis, and radiation 4.Polluted water and air

ANS:2 The newer threats to health that public health nurses are involved in are HIV, AIDS, and bioterrorism. Choice #1 lists threats of the past. Avian flu may be a threat, but radiation and tuberculosis are ongoing. Polluted water and air are generally not seen in the United States.

The Frontier Nursing Service was established by Mary Breckinridge to emulate systems of care used in the Highlands of Scotland. Her biggest contribution was: 1.Establishment of the Henry Street Settlement 2.Development of health programs geared toward improving the health care of the rural and often inaccessible populations 3.Blazing a nursing trail through the Rockies, providing nursing care to miners and their families 4.Teaching birth control measures to large numbers of women in the South

ANS:2 Mary Breckenridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Lillian Wald established the Henry Street Settlement.

Early colonial health efforts in the United States included: 1.Establishment of schools of nursing 2.Development of vaccines given to large numbers of people 3.Collection of vital statistics, improved sanitation, and control of communicable diseases introduced through seaports 4.Development of public housing and almshouses

ANS:3 The other choices are events that happened after the colonial period.

Occupational health nursing began as industrial nursing. What was the purpose of this type of nursing? 1.Inventing new machines to streamline production of medical goods 2.Investigating industrial injuries to improve work conditions 3.Working at industrial sites treating work related-injuries 4.Providing care for factory workers and their families

ANS:4 Early occupational health nursing did not provide care for work-related injuries, but instead focused on the care of employees and their families in the home.

Lillian Wald was the first public health nurse in the United States. Which of the following is her major contribution to public health nursing? 1. Founding the American Nurses Association 2.Establishment of the New York Training Hospital for Nurses 3.Establishment of the Public Health Service 4.Establishment of the Henry Street Settlement that later became the Visiting Nurse Service of New York

ANS:4 Lillian Wald established the Henry Street Settlement.

A nursing student during World War II would likely join which group? 1.The Public Health Service of New York City 2.The Marine Nurse Corps 3.The Frontier Nursing Service 4.The Cadet Nurse Corps

ANS:4 The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels.

What has happened to the funds set aside for nutrition and food programs, such as WIC? a. They have decreased a small amount in an effort to be fair to everyone b. They have increased the recognition of the number of low-income mothers seeking assistance c. They have been maintained at current levels, even though more women are documenting eligibility for help d. They have been sharply reduced with benefits limited to one year

D WIC was sharply curtailed so mothers living with others could have only 1 year of benefits, women in prison or detention centers were denied benefits for their children, and adults without children could have only 3 months of assistance every 3 years.

Which populations are at greatest risk for disruption after a disaster? Select all that apply. a. Single-parent families b. Children c. Substance abusers d. Middle-class families

a. Single-parent families b. Children c. Substance abusers

A nurse is working in a temporary shelter for victims following a natural disaster. Which condition is the nurse most likely to encounter? a. Stress b. Communicable disease c. Chronic illness d. Injuries requiring first aid

a. Stress

When the nurse accepted a position at the local community health center, the nurse was told to not ask the immigration status of any client. Why would an agency have such a policy? a. Agency personnel do not want to get involved in political or legal concerns in any possible way. b. All state and federally funded programs are barred from using funds to care for illegal immigrants, so care can only be given if status is unknown. c. The agency did not want to inadvertently refuse care to a U.S. citizen by constantly requiring documentation, which wastes agency time, effort, and money. d. The agency recognizes that immigration status has no bearing on a client's health or need for care, so there is no reason to ask.

B All states are required to bar illegal immigrants from state and locally funded programs. This ruling has created a dilemma for health care workers, who feel they have been asked to operate as agents of Immigration Services. Many facilities simply do not ask immigration status when providing care.

What were some of the effects of welfare reform? Select all that apply. a. Additional governmental agencies have been established to fill in the gaps in services. b. Earned Income Tax Credit helps increase income among low-income families. c. Fewer people can use the system to their own personal advantage. d. Lacking transportation and child care, many parents cannot seek or retain employment. e. More children are able to receive health insurance assistance. f. Very few people can receive assistance while earning a GED or attending remedial classes.

B, D, F Long-term effects of welfare reform on families include a drop in the number and percentage of needy families receiving help; lower average payment (the Earned Income Tax Credit) helps increase income; many children lost their health insurance; time limitations resulted in families losing benefits; educational pursuits are no longer considered a work activity; and the number of extremely poor is increasing. All of these have put vulnerable groups even more at risk for health problems.

Which is an example of a human-made disaster? a. Structural collapse b. Communicable disease epidemics c. Mud slides d. Floods

a. Structural collapse

Which statement about disasters is true? a. They can be natural or human-made. b. They can be relieved without assistance. c. There is always injury and death when a disaster occurs. d. The timing of a disaster does not influence the types of injuries that will occur.

a. They can be natural or human-made.

Which of the following is an example of the mission of public health according to the Institute of Medicine? a.Tracking avian flu outbreaks and doing surveillance in the United States b.Providing a flu shot for an elderly person at the health department c.Keeping track of alternative therapies in use in the United States d.Keeping snake antivenom at the Centers for Disease Control and Prevention in Atlanta

a. Tracking avian flu outbreaks and doing surveillance in the United States

The two wage earners in a family with four children have recently become unemployed. Suddenly, they are unsure as to how they are going to pay their mortgage, monthly bills, and purchase groceries. To which of the following governmental assistance programs would the nurse most likely refer this family? a. Aid to Families with Dependent Children (AFDC) b. Medicaid c. Temporary Assistance for Needy Families (TANF) d. Women, Infants, and Children Program (WIC)

C AFDC was abolished under the Welfare Reform Act, and TANF replaced it. The two biggest programs are TANF and Social Security Income (SSI), but both programs only cover about one third of the 37 million people below the poverty line. TANF provides temporary financial assistance to needy families with dependent children. Medicaid provides health care services to certain people in need. WIC provides supplemental food and formula for infants, young children, and pregnant and new mothers.

In 2010, how many people fell below the poverty in the United States? a. About 4.5% or 13 million people b. About 8.5% or 25 million people c. About 15.1% or 46 million people d. Fewer people than in the year 2008

C According to the U.S. Census Bureau (2010), 15.1% of all people in the United States fall below the poverty level, or about 46 million, an increase of 6.6 million since 2008.

What is an extremely important strategy that a community/public health nurse can take to assist vulnerable families? a. Encourage the families to find and use free food distribution centers b. Encourage the families to find and attend so-called free clinics for health care c. Share information about local assistance programs and eligibility requirements d. Write letters to the editor in the local newspapers

C Although letters to the editor might be helpful, it would be more effective for the nurse to write about community problems than for individual families to beg for help. Certainly sharing the location of community resources is central to the nurses' role, including eligibility requirements and benefits available for food, clothing, housing, emotional support, etc.

How has requiring proof of citizenship for all Medicaid recipients caused a problem for these clients? a. Additional paperwork always increases workload and costs for agencies. b. Citizens are not accustomed to having to prove they are citizens and may not have appropriate documentation immediately available. c. Many low-income people do not have driver's licenses or birth certificates immediately available with which to prove citizenship. d. Most agencies recognize that immigration status has no bearing on a client's need for Medicaid assistance.

C Congress requires states to demand proof of citizenship, which is an additional administrative burden that causes delay in Medicaid coverage for families. Poor people are particularly at risk because many do not have passports, driver's licenses, or birth certificates.

What is the relationship between race and ethnicity and health status? a. Ethnic and racial minorities are equally as vulnerable to poor health status as the rest of the population. b. Ethnic and racial minorities are less vulnerable to poor health status than the rest of the population. c. Ethnic and racial minorities are more vulnerable to poor health status than the rest of the population. d. There is no significant relationship between ethnic and racial background and health status.

C Ethnic and racial minorities are more vulnerable to poor health status than the rest of the population because minorities are at greater risk for poverty. Other factors include discrimination and some health behaviors and beliefs.

An uninsured child lives in a family which has an income level below the poverty level. Under which of the following programs can this child receive health care? a. Children's "Health For All" initiative b. "No Child Left Behind" Act c. State Children's Health Insurance Program d. Temporary Assistance to Needy Families Program

C The uninsured rate for children has been cut in half because of the 1997 passage of the State Children's Health Insurance Program. Despite the success of CHIP, eligible children are still missed and are not receiving care.

By definition, what must a group be in order to be considered a "vulnerable" population? Select all that apply. a. Aware that they are "at risk" b. Diagnosed with an observable medical problem c. Have difficulty obtaining appropriate health care d. Acutely ill with several comorbidities e. Likely to develop health-related problems f. Probably confronting a shorter life span than others their age

C, E, F By definition, a vulnerable population has mitigating factors that place them at greater risk for ongoing poor health status than other at-risk people or groups. A vulnerable population is more likely to develop health-related problems, have more difficulty accessing health care to address those health problems, and is more likely to experience a poor outcome or shorter life span from those health conditions. Awareness of problems is not a factor, since many diseases, such as hypertension, do not have observable symptoms and may not be diagnosed because the person may not have sought assistance.

Which task would a nurse be most likely to perform while volunteering on a disaster medical assistant team? a. Set up immunization clinics. b. Assist in triaging disaster victims. c. Provide all the medical care for disaster victims. d. Complete a needs assessment of the community.

b. Assist in triaging disaster victims.

What emotion would a nurse anticipate when working with an older person following a disaster? a. Anger b. Fear of loss of independence c. Violence d. Regression

b. Fear of loss of independence

The middle-aged white woman seemed unable to relate to the staff in any meaningful way or to behave in an appropriate manner in the emergency department, where the police officer had brought her as a result of inappropriate behavior at a public gathering. Which of the following would best describe this woman? a. A public nuisance b. An unfortunate drain on society c. Extremely mentally and physically ill d. Psychologically and socially decompensated

D A homeless woman with such symptoms is said to be suffering from psychological and social decomposition. That is, she is unable to interact with others by communicating well or behaving in socially acceptable ways and is emotionally and mentally separated from society

A single adult male is employed full-time and is earning the minimum wage. Under which of the following conditions could he afford housing? a. If he combines his earnings with another adult who is employed part-time b. If he chooses to live in a one-room efficiency apartment c. If he lives in an apartment located in a low-income housing area d. If he uses over 50% of his net income to pay for housing

D An estimated 7.1 million low-income households spend more than 50% of their income on housing with no assistance from public assistance housing programs. Such households are one paycheck away from being homeless. Two adults, both employed full-time, may be able to rent a small apartment, but it is still difficult to save enough for the required deposit on a rental.

The nurse was assessing a child who had spent the last 3 years living with her mother in homeless family shelters. Which of the following would the nurse expect of the child in relation to intellectual development? a. Development is somewhat below grade level b. Development is above grade level c. Development is at the appropriate grade level d. Development is quite low for her age and grade level

D Many homeless children have attended school programs on a sporadic basis. They often have deficiencies in acquiring learning readiness and social interaction skills and experience long intervals between school attendances. This lost school time results in academic underachievement and gaps in learning and experience.

Which of the following populations was most affected by the federal budget cuts made in 1996? a. The upper and middle class b. The wealthy c. The lower-middle class d. The poverty-stricken

D Poverty programs were cut in 1996 under the Personal Responsibility and Work Opportunity Reconciliation Act, also known as the Welfare Reform Act.

The nurse wanted to engage in primary prevention in relation to the vulnerable populations for whom the nurse provided care. For what might the nurse choose to volunteer? a. Counselor at the homeless shelter b. Instructor for the community college home aide course c. Nurse in a homeless clinic d. Speaker to community groups as an advocate for vulnerable groups

D Primary prevention tries to prevent health problems. Therefore, the nurse must advocate for vulnerable groups and speak to community groups on such issues as the need for low-cost housing and funding for poverty-level families.

Although single men are the largest single group of homeless people, which of the following is the fastest growing group of homeless people? a. Adolescents b. Adult single women c. Elderly d. Families with children

D Single homeless men still make up the largest and most visible subgroup of the homeless. However, families with children are the fastest growing group.

Approximately what percentage of the American population does not have health insurance according to the U.S. Census Bureau? a. 4% b. 8% c. 12% d. 16%

D The U.S. Census Bureau reports about 49.9 million Americans, or 16.3% of the population, do not have health insurance.

What is the single most crucial variable associated with health status? a. Cultural background b. Ethnic group c. Race d. Socioeconomic class

D The most important factor associated with health status is economic status. Poverty drastically increases a person's/group's vulnerability to poor health status

What is anticipated to happen in the future with disaster management? a. Vague and unorganized future because constant emergence of new disasters b. Increasing sophistication in technology and surveillance c. Lack of involvement by national and state officials d. Decreasing need for public health workers to provide care

b. Increasing sophistication in technology and surveillance

If a bioterrorism attack was to occur in the United States, which program would be used to provide large quantities of medication to the American public? a. Cities Readiness Initiative b. Strategic National Stockpile (SNS) c. Public Health Information Network (PHIN) d. Project BioShield

b. Strategic National Stockpile (SNS)

What is most likely to occur in the community during the Honeymoon Phase after a disaster? a. First responders work tirelessly to save others. b. Survivors share their stories. c. Medical personnel experience exhaustion. d. Community organizations rebuild the community.

b. Survivors share their stories.

The use of weapons of mass destruction or natural disasters, such as earthquakes, will often have more casualties because: a. They cause the most widespread destruction. b. Victims have little time to make evacuation preparations. c. Those with chronic conditions cannot escape in time. d. The early warning systems are not effective.

b. Victims have little time to make evacuation preparations.

What is the first action a nurse should take when assessing persons arriving at a shelter following a disaster? a. Limit the amount of equipment and medications brought into the shelter. b. Determine if the person has a psychological condition requiring special attention. c. Assess whether this type of facility is appropriate for the person. d. Provide medical care for persons as if they were in a hospital.

c. Assess whether this type of facility is appropriate for the person.

What action would the nurse take when triaging victims following a disaster? a. Allocation of treatment based on the victim's potential for survival b. Assignment of tasks to the appropriate disaster response personnel c. Determination of the level of disaster and agency involvement d. Participation in community preparedness for the disaster response

a. Allocation of treatment based on the victim's potential for survival

Which organizations offer volunteer opportunities in disaster work for nurses? Select all that apply. a. American Red Cross b. Citizens Corps c. American Nurses Association d. National Public Health Training Centers

a. American Red Cross b. Citizens Corps

One of the primary focuses of improving the health of the American people in the twenty-first century is to address: a.Bioterrorism and global health threats b.Delivery of individual care and hygiene c.The need for increased hospital and acute care d.Chronic disease and disability management

a. Bioterrorism and global health threats

When working in a disaster, which attribute would be most important for the nurse to possess? a. Flexibility b. Training c. Experience d. Special interest

a. Flexibility

A riverfront community builds a retaining wall to divert flood water away from the town. This is an example of: a. Mitigation b. A natural disaster c. Disaster reduction d. Disaster health

a. Mitigation

Which is an example of a natural disaster? a. Transportation accident b. Pollution c. Communicable disease epidemic d. Fire

c. Communicable disease epidemic